Provider Demographics
NPI:1518169200
Name:BOARD OF REGENTS NEVADA SYSTEM OF HIGHER EDUCATION
Entity Type:Organization
Organization Name:BOARD OF REGENTS NEVADA SYSTEM OF HIGHER EDUCATION
Other - Org Name:CSN - DENTAL FACULTY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL SERVICES MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-651-5514
Mailing Address - Street 1:6375 W CHARLESTON BLVD STE A500
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1168
Mailing Address - Country:US
Mailing Address - Phone:702-651-5514
Mailing Address - Fax:702-651-7383
Practice Address - Street 1:6375 W CHARLESTON BLVD STE A500
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1168
Practice Address - Country:US
Practice Address - Phone:702-651-5514
Practice Address - Fax:702-651-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)